Effect of a Structured Preoperative Educational Video on Maternal Anxiety in Elective Cesarean Section: A Randomized Controlled Trial Using EEG Biomarkers.

OBJECTIVE: Preoperative anxiety is common in patients undergoing elective cesarean section and may worsen perioperative outcomes. This study evaluated whether a structured preoperative educational video (SPEV) reduces maternal anxiety, as measured by the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the quantitative electroencephalography (QEEG)-derived theta-beta ratio (TBR). METHODS: Ninety primigravida women undergoing elective cesarean section with spinal anaesthesia were randomized to a video group (n = 45; SPEV plus routine counseling) or a control group (n = 45; routine counseling only). APAIS was measured at baseline and 30 minutes before surgery. Parietal TBR was recorded at baseline, 30 minutes before surgery, and 1 hour after surgery. Groups were compared using appropriate non-parametric tests, and the correlation between subjective and QEEG-derived measures was assessed. RESULTS: Baseline characteristics were comparable between groups. At 30 minutes before surgery, APAIS scores were lower in the video group than in the control group [11.0 (9.0-12.0) vs. 14.0 (12.0-16.0); P < 0.001). TBR was also lower before surgery (1.20 vs. 1.90; P < 0.001) and at 1 hour postoperatively (1.20 vs. 1.80; P < 0.001). A positive correlation between APAIS scores and TBR was observed 30 minutes before surgery (P=0.48, P < 0.001). Intraoperative midazolam requirement was lower in the video group (11.1% vs. 33.3%, P=0.021). CONCLUSION: A SPEV significantly reduced preoperative anxiety in women undergoing elective cesarean section, as demonstrated by both subjective and QEEG-derived measures, and was associated with reduced intraoperative anxiolytic requirements.